| NPI | 1821100504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01058750A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 24137) |
| 207R00000X Internal Medicine (Licence: NC 2012-00404) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2017-01-23 |